The Food and Drug Administration has approved a radio-frequency identification tool that tracks instruments and sponges during surgical procedures.
ORLocate, developed by Maumelle, AR-based Haldor Advanced Technologies Ltd., provides:
Anytime initial counts and item additions
The number of items missing
The number of clean and soiled sponges
The time of the last count.
The system uses radio-frequency identification to help surgical teams reduce the number of items left in patients during operations, and is designed to improve patient safety and decrease complex and time-consuming counting procedures that are prone to human error. ORLocate is the only RFID-based system that counts sponges and surgical instruments, Haldor says.
“Surgical teams must rely today on manually counting surgical items to ensure that sponges and instruments are not left in patients,” says Jacob Poremba, president/CEO of Haldor USA Inc. “This leaves enough room for errors, causing large hospitals to experience about two to four cases annually of a surgical item left inside a patient after surgery.”
More than a third of all retained surgical items are instruments (52% radiopaque sponges and 43% instruments), according to a 2007 study in the Journal of Surgical Research. Correcting such errors adds about $2 billion each year to the nation's medical bill.
ORLocate tested 99.8% accurate when counting and monitoring the location of sponges and instruments during lab testing by NAMSA in Northwood, OH, and labs in Germany and Israel. ORLocate tags each item used in surgery with a unique RFID identity. The tag is about the size of a hearing aid battery. The tagged instruments and sponges are detected via antennas located throughout the sterile field and software that continuously and automatically performs the counting.
Before procedures, a count of items is registered, and as they are used, the information is logged electronically. Before the procedure is completed, ORLocate has accounted for each item to ensure the safety and wellbeing of the patient, while increasing efficiency of operating room logistics and workflow processes.
The RFID technology allows ORLocate to:
Provide a complete and integrated solution to help reduce cases of retained surgical items in patients’ bodies.
Combine tracking technology and asset management services.
Potentially increase efficiency of operating room logistics and workflow processes.
Reduce time-consuming counting and inventory management.
Enable simple and accurate packing of surgery sets in the sterile processing department. .
Marin General Hospital Corp. has filed a suit against Sutter Health Corp. to recover more than $120 million that Marin claims Sutter improperly took from hospital's accounts for four years.
The suit alleges that since 2006, Sutter removed more than $30 million a year from Marin General's reserves, moving the money into Sutter accounts for its own benefit. In the five years before that, Sutter had made "cash sweeps" of less than $3 million a year.
"Sutter utterly ignored its fiduciary responsibility to Marin General and instead chose to line its own pockets with the hospital's reserves," says James J. Brosnahan, senior partner at Morrison & Foerster, the lead litigation attorney for the Marin General board. "It's improper, immoral and reprehensible conduct by a company that was trusted to manage this vital community resource."
Kathie Graham, communications and public affairs director for Sutter Health's West Bay Region, says she couldn't specifically comment on the suit because Sutter hasn't reviewed the allegations. "However, we can say that it is indeed regrettable that the Marin Healthcare District has elected to pursue legal action as there is no basis whatsoever for any such action," she added.
"Sutter Health complied in all respects with the legal agreements governing the transfer of Marin General Hospital and expended considerable resources above and beyond what we were required to do so as to ensure a smooth transition of the hospital. We have responded to the District's concerns throughout the transition and have explained our financial policies to the satisfaction of the regulatory agencies that govern non-profit healthcare entities. While we had hoped to put the contentious relationship of the past behind us, Sutter Health will now vigorously defend itself and will likewise vigorously pursue all claims against the Marin Healthcare District."
The alleged behavior detailed in the lawsuit, filed Thursday in Superior Court in Marin County, began when Sutter Health Corp. sought to end its 20-year management contract with Marin General five years early. After agreeing to a 2010 termination, Sutter began the massive cash transfers and sought to undermine Marin General as a future competitor, the suit alleges.
"Sutter asked Marin General for a 'divorce' and then decided they'd just clean out the bank account before the divorce became final," Brosnahan says. "The Board has worked for months to get Sutter to return the $120 million that doesn't belong to them, and time and again they have refused. Now they will have to explain to a judge and jury this massive wealth transfer and conflict of interest."
Sutter's improper and intentional actions depleted the reserves required to invest in the long-term future and continued modernization of the community's major hospital and its only trauma center, Marin General alleges.
"This action is not about money, but what that money represents: The ability for us to provide for the future health and welfare of Marin General Hospital and the people of Marin County," says Tim Sowerby, MD, of the Marin General Hospital Board. "The board has a fiduciary responsibility to recover the money Sutter took to fund fully our reserves—the down payment on the Hospital's future. That will enable Marin General to continue offering the community the highest level of healthcare and the most modern facility today and into the future."
Marin General alleges that Sutter removed the more than $120 million by creating a conflicted hospital governing board that included Sutter employees, who were paid by Sutter and depended for their livelihood and career advancement on Sutter management, and others who would follow Sutter's direction.
The Sutter board allegedly had detailed knowledge of the huge sums of cash taken by Sutter—including exact amounts—and the effect the removal of this money had on Marin General's finances. Because of the clear conflict of interest, however, the board never discussed or questioned the appropriateness of Sutter seizing this money, despite the damage being done to Marin General, Marin General alleges in its suit.
While Sutter was allegedly removing millions from Marin General, it also was investing millions in active healthcare operations in Marin County, in direct competition with Marin General and in violation of its agreements. Sutter sought to lease most of the available medical office space in close proximity to Marin General, refused to recruit physicians for Marin General, purchased a plot of land for new Sutter healthcare facilities, and even forced Marin General to pay for Sutter's pension obligations, Marin General alleges.
HealthSpring, Inc. announced Friday that it will pay $545 million to purchase Bravo Health, Inc., a privately held operator of Medicare Advantage plans in Pennsylvania, the Mid-Atlantic region, and Texas, and Medicare Part D stand-alone prescription drug plans in 43 states.
The deal creates the largest company in the nation focused solely on the Medicare Advantage population, including the seventh-largest Medicare Advantage plan, and the ninth-largest stand-alone prescription drug plan.
Bravo Health's August 2010 plan payment reports reflected aggregate Medicare Advantage and PDP membership of over 100,000 and 290,000, respectively. For the first six months of 2010, Bravo Health generated premium revenue of approximately $832.8 million.
"I cannot think of a better way to demonstrate our commitment to Medicare Advantage and our confidence in the long-term future of the program than the transaction we are announcing today, said Herb Fritch, chairman/CEO of Nashville-based HealthSpring. "This acquisition will extend HealthSpring's reach into new geographies, including an immediate and sizable presence in the Philadelphia market. With diversified geography and increased membership scale, the combined companies will be even better positioned in the new environment created by health insurance reform."
Jeff Folick, CEO/chairman of Baltimore-based Bravo Health, called the acquisition "the right next step for our company, and we are fortunate to be aligning ourselves with an organization that is so similar to ours."
HealthSpring already owns and operates Medicare Advantage plans in Alabama, Florida, Georgia, Illinois, Mississippi, Tennessee, and Texas and also has a national stand-alone Medicare prescription drug plan.
The deal will be financed with unrestricted cash and borrowings under an amended revolving credit facility and new term loan facilities that will be established simultaneously with the closing of the transaction. HealthSpring has entered into a $750 million financing commitment with JPMorgan Chase Bank, N.A.; Bank of America Merrill Lynch; and Raymond James Bank, FSB. The commitment consists of an amendment to HealthSpring's existing $350 million credit facility combined with $400 million of new loans.
The deal is expected to close by the end of the year and should add $.45 to $.55 to HealthSpring's 2011 earnings per share. HealthSpring expects that transaction expenses, including financing commitment, financial advisory, and other fees, will impact 2010 earnings by about $.20. The transaction does not need HealthSpring stockholders' approval, but is subject to federal and state regulatory approvals.
The Centers for Medicare & Medicaid this week reminded healthcare providers, health plans, clearinghouses, and vendors about looming compliance deadlines for new diagnosis and procedure codes, and updated standards for electronic healthcare transactions.
The first compliance milestone for the Accredited Standards Committee X12 Technical Reports Type 3, Version 005010 (Version 5010) electronic healthcare transaction standards begins on Jan. 1, 2011. By then, HIPAA-covered entities should be ready to test the functionality of practice management and related software featuring Version 5010 standards.
Use of the Version 5010 standards for HIPAA electronic healthcare transactions, including claims, remittance advice, eligibility inquiries, referral authorization, and other administrative transactions, becomes mandatory on Jan. 1, 2012. Version 5010 standards also provide the framework for ICD-10-CM and ICD-10-PCS revised medical data code sets that must be in place on Oct. 1, 2013.
"The Version 5010 standards and ICD-10 codes are necessary steps to facilitate the national transition to an electronic healthcare environment," says CMS Administrator Donald Berwick, MD. "Transitioning to the Version 5010 transaction standards in 2012 and to the ICD-10 codes in 2013 will help accelerate the widespread adoption of health information technology and move the nation toward a more efficient, quality-focused healthcare system."
The expanded ICD-10 code sets will support quality reporting, pay-for-performance, bio-surveillance, and other critical activities, and provide terminology for electronic health records. The ICD-10 code sets will also link to the standards and certification criteria for demonstrating meaningful use of certified EHR technology under the Medicare/Medicaid EHR incentive program.
"We have many information resources and outreach activities in place to facilitate compliance with both Version 5010 and ICD-10, and we are proactively working with partner organizations to ease the transition," says Marilyn Tavenner, CMS principal deputy administrator, "Beginning January 2011, the Medicare Fee for Service program will be ready to test Version 5010 transaction standards with its external partners, and we anticipate that other industry segments will be poised to follow suit."
Also facing a Jan. 1, 2012 installation deadline is the National Council for Prescription Drug Programs Version D.0 standard for retail pharmacy transactions, and NCPDP Version 3.0, the standard for the Medicaid pharmacy subrogation transaction. Small health plans have an additional year and must be compliant with Version 3.0 on Jan. 1, 2013.
To help healthcare providers, health plans, clearinghouses, and vendors work toward the compliance dates for Version 5010 and ICD-10—and avoid delays in claims processing and payment—CMS has been conducting ongoing industry outreach and education, and, most notably, has revised its ICD-10 Web site.
"We have refocused our efforts on making available a full range of resources, including fact sheets, timelines, videos and other materials, at our ICD-10 Web site," says Tony Trenkle, Director of CMS' Office of E-Health Standards and Services.
"All of the information is free and can be downloaded. We have also worked closely with our industry and stakeholder partners to push out important messages through their respective communications vehicles, and we have identified their Version 5010/ICD-10 materials and provided links to their publically accessible Web sites."
The University of Southern Nevada and St. Rose Dominican Hospitals have created an Accelerated Bachelor's Degree in Nursing program that will allow applicants who've already earned a bachelor's degree to become an RN after 14 months of additional study.
The USN program combines online courses and on-site labs taught by USN faculty with clinical rotations at St. Rose facilities and other clinical sites in Southern Nevada.
"Our three hospitals are well-known for providing quality, compassionate healthcare for the community, and our nurses are one of the main reasons we are able to provide that high level of care," says Rod A. Davis, president/CEO of St. Rose Dominican Hospitals. "We are looking forward to working with the USN College of Nursing to provide this much needed educational resource to our community."
The Nevada Department of Employment, Training and Rehabilitation has estimated that nearly 5,500 new nurses will be needed statewide by 2016. Over the next few years, it is anticipated that the nursing occupation will grow by 37%, with an average annual growth rate of 3%, offering employment possibilities in a state now mired with a 14.2% unemployment rate, the highest in the nation.
As the economy improves, it is expected that the demand for nurses will increase. Nurses who delayed retirement during the economic downturn will retire. Part-time nurses who went full-time because of an unemployed or underemployed spouse will resume their part time schedules, and patients will seek treatment for elective procedures they postponed to save out-of-pocket expenses. In addition, healthcare reform and an aging baby boomer generation will create increased demand for nurses for an already stressed national healthcare system that will be short one million nurses by 2020.
The program curriculum focuses on clinical areas including medical surgical, obstetrics, mental-community health, maternal-newborn, and pediatrics nursing.
St. Rose Dominican Hospitals is affiliated with Adrian Dominican Sisters and Catholic Healthcare West. With three hospitals—Rose de Lima, Siena, and San Martin—St. Rose Dominican is the only not-for-profit, religiously sponsored hospital system in Las Vegas.
Louisville, KY-based Kindred Healthcare, Inc. announced plans to acquire five long-term acute care hospitals in Southern California, and three nursing homes in Dallas-Fort Worth in two separate cash deals totaling $218 million this week.
Kindred will pay $180 million to Rancho Cucamonga, CA-based Vista Healthcare, LLC, for the four freestanding hospitals and one hospital-in-hospital with a total of 250 beds. The assets generate annual revenues of approximately $150 million and earnings before interest, income taxes, depreciation and amortization of approximately $27 million.
"We view the Vista transaction as a great opportunity to meet the growing demand for our services in southern California and expand our hospital operations,” Kindred CEO Paul J. Diaz says. “The Vista hospitals also provide several clinical service offerings not currently available in our area hospitals providing us with an opportunity to expand our clinical services as well as attract more commercial and managed care business.”
Vista President/CEO Ara Tavitian, MD, says the combined strengths of the two companies “will promote expanded services and clinical programs that will better serve our patients and their families.
Kindred also offers our employees the ability to expand their opportunities with a proven and dynamic healthcare provider. We look forward to integrating our operations with Kindred and to the continued growth and development of our combined services."
Kindred will also pay $38 million for three recently constructed nursing and rehabilitation centers in the Dallas-Fort Worth market, where Kindred already operates six hospitals and is developing a co-located hospital-based subacute unit. Kindred intends to develop two of the nursing centers into transitional care centers, focused on short-term rehabilitation and medically complex patients, and add a transitional care unit to the third nursing center.
These three nursing and rehabilitation centers have 405 beds and annual revenues of $24 million and EBITDA of $3 million.
“The nursing and rehabilitation center transaction offers us the opportunity to acquire three relatively new, owned facilities and develop them into transitional care centers to complement our existing hospital services in the Dallas-Fort Worth cluster market, where we currently operate six hospitals,” Diaz says. “This transaction also allows us to continue to add to our owned real property base.”
Both acquisitions are subject to regulatory approval and are expected to close this year. Kindred will finance both deals from its revolving credit facility, but the company is not acquiring the capital, or assuming liabilities in either deal.
In the year immediately following the transactions, Kindred said it expects to incur transition costs of between $6 million to $8 million.
Rio Grande Regional Hospital in McAllen, TX, has been given a Level III trauma designation from the Texas Department of State Health Services—becoming one of only four hospitals in South Texas to receive certification for this level of care, the HCA Gulf Coast Division affiliate announced.
"Rio Grande Regional Hospital is already known for its excellent trauma care and our commitment to pursuing excellence in care," said Greg Seiler, CEO of the 320-bed acute care hospital. "By receiving the Level III designation, we continue to meet the needs of our growing community by providing quality trauma intervention and treatment."
Trauma surgeons and hospital staff are available 24 hours a day at the hospital. Specially trained nurses attend each trauma patient throughout the day for care advancement and coordination. Trauma data is collected and entered into a registry database for quality improvement and injury prevention initiatives. The trauma coordinator provides trauma education throughout the hospital.
HCA affiliated facilities in the Gulf Coast Division include 12 hospitals, seven ambulatory surgery centers, four free standing emergency centers, five imaging centers, five cancer care programs and a Regional Transfer Center. The Regional Transfer Center provides ground and air patient transportation to and from any HCA Houston Affiliated Hospital and any other healthcare facilities.
The Texas Medical Association is hailing a state judge's announced intention to impose limits on chiropractors' rights to diagnose medical conditions.
Texas District Judge Stephen Yelenosky said last week in a letter to lawyers handing the case that he would invalidate the Texas State Board of Chiropractor Examiners rules that would have allowed chiropractors to diagnose all medical conditions.
Yelenosky had earlier ruled that a chiropractic license does not authorize chiropractors to perform manipulations under anesthesia and needle electromyography procedures. The judge upheld chiropractors' authority to diagnose conditions that do fall within their scope. A final ruling is expected in a couple of weeks.
The judge's letter follows a ruling in November in which he granted a TMA and Texas Medical Board request for a partial summary judgment against the chiropractic board and the Texas Chiropractic Association. He said then that the wording of state law is ambiguous, but that a review of the legislative debate over the issue "clearly reveals" that lawmakers "intended to prohibit the Board of Chiropractic from allowing any chiropractor to perform MUA."
TMA sued in 2006 to block the chiropractic board's rules because, the association said, the MUA and need EMG constitute the clinical and legal practice of medicine.
Broward General Medical Center in Fort Lauderdale has been granted a Certificate of Need by the Florida Agency for Health Care Administration to continue its six-year-old adult liver transplantation program. With the approval Broward General will have its own stand alone program.
In June 2003, Broward General Medical Center and Jackson Memorial Hospital were granted permission by AHCA for the first-of-its-kind shared servicearrangement for transplant surgery. The first transplant took place in February 2004. Since then, Broward General has performed between 35 to 40 liver transplants each year.
"The program is a critical component in our list of healthcare services to the community we serve," says Frank Nask, president/CEO of Broward Health. "By teaming up with the University of Miami physicians, Broward Health can continue to offer our patients liver transplant services."
Broward Health is one of the 10 largest public health systems in the nation, Broward Health includes Broward General Medical Center, North Broward Medical Center, Imperial Point Medical Center, Coral Springs Medical Center, Chris Evert Children's Hospital, Broward Health Weston and more than 30 facilities of the Community Health Services and Broward Health Physician Group.
The best part of my job is the people I get to meet—particularly the frontline, hands-on medical professionals who see their work as a calling. It sounds corny, but these people are healers in the noblest sense. In a world full of silliness and superficiality, selfishness, and cruelty, it's therapeutic and a great perspective adjuster to be around these well-grounded people.
So, it was with great sadness when I read last week that David Nichols, MD, a lifelong family physician in Virginia and dedicated healthcare professional confirmed that he is suffering from terminal cancer and has only a few months to live.
"I actually feel very well, but I know it's coming," Nichols, 62, told the Associated Press, in a piece you should post on the break room bulletin board. "I feel very blessed to have lived the life I have."
You probably have never heard of Doc Nichols. That's not surprising. Unless you're one of the thousands of people he's treated over the decades there is no reason to know him. People like Doc Nichols don't usually draw attention to themselves. They're too busy.
I was fortunate to interview him almost four years ago in a piece on rural physicians. He had just been named the 2006 Country Doctor of the Year by physician recruiters Staff Care, having been nominated on the sly by his colleagues.
Doc Nichols told me about his 90-hour work weeks, and his tiny three-physician practice in White Stone, near the mouth of the Rappahannock River in coastal Virginia. And he told me about his life's work as a volunteer physician on Tangier Island, about 25 miles out in Chesapeake Bay. For the last three decades, Nichols has flown himself and colleagues to the island every Thursday to provide the 600 or so residents of the tiny fishing community with, often, their only access to healthcare. This island is so remote that linguists claim the inhabitants still speak a dialect similar to Elizabethan English.
Doc Nichols was the subject of a piece I was writing about the good old fashioned family doctor in rural America, and what we're going to do when they're gone.
He said at the time that many younger physicians are talented and dedicated, but aren’t willing to put in the long hours that senior colleagues like him simply assumed came with the territory.
“The next generation of family practice doctors doesn’t want to work as hard as we did, so it’s probably going to take two of them to equal what one of us has been doing. I can see that happening right now,” he said. “I don’t fault them for that. They have a different perspective, and it’s pretty logical what they are saying. They put a greater emphasis on family and time off and less emphasis on working all the time.”
He said all of this with no rancor, and acknowledged that he and his kind were a dying breed, adding "I know I am a dinosaur."
Doc Nichols said the working climate for primary care physicians isn’t helping, with Medicare reimbursements facing cuts and malpractice liability rising every year. The more time needed to complete paperwork, meet OSHA requirements and address other business-side concerns means less time with patients, reducing the quality of care, and revenue.
With all of those distractions, though, he had no immediate plans for retirement before the bad news came last month that melanoma he'd fought six years ago had returned and spread to his liver.
"He's been coming here since I was a little girl," island resident Jamie Bradshaw told AP, wiping her eyes after hugging Nichols. "I don't know what we'd do without him. I can't even describe in words what he's meant to all of us."
The terrible news comes as the island is readying-this week-the grand opening of a new $1.7 million medical clinic, five times bigger than the 1950s-era clinic that Nichols has staffed for more than 30 years.
Nichols told AP he'd hoped to stick around a little longer, but the cancer has other ideas, and he has accepted his fate with dignity. He plans to be buried in the church yard-a stone's soft toss from the new clinic. "It's the journey that's counted for me," Nichols told AP. "Sure I'll miss being able to do all those things I'd planned to do, but, gosh, this was so rewarding."
